The ASAM levels of care are a standard scale for addiction treatment, running from outpatient therapy a few hours a week to 24-hour medical care in a hospital. Clinicians use them to match a person to the least intensive setting that is still safe and effective for that person’s needs.
Levels differ in clinical intensity, setting, and medical capabilities, rather than simply adding hours. A partial hospitalization program in South Florida, for example, provides substantial daytime care with nights elsewhere. This guide covers the fourth edition’s adult continuum; adolescent standards and individual program requirements can differ.
What Are the ASAM Criteria?
The ASAM Criteria are standards from the American Society of Addiction Medicine, a national medical society for clinicians in addiction medicine. They describe how to assess people with substance use disorders and which level of care fits each person. ASAM first published them in 1991, when they were called the ASAM patient placement criteria [1].
The criteria also give each level defined service characteristics, meaning the staffing, hours, and services a treatment program needs to offer at that level. Many people first meet the criteria during an intake assessment, often soon after deciding they are ready for addiction treatment.
Who Uses the ASAM Criteria
Many addiction treatment providers, state behavioral health agencies, and health plans use the ASAM Criteria. Clinicians use them for patient placement and treatment planning. Health plans use them for utilization management, the review process that decides whether a service is covered.
ASAM offers training for clinicians and health plans and notes that jurisdictions adopt editions at different rates [2]. Shared terminology can improve communication, but a level number does not guarantee identical implementation across every provider or insurer.
What Changed in the Fourth Edition
The adult volume of The ASAM Criteria Fourth Edition was published October 5, 2023 [3]. It renamed several levels, removed Level 3.3 and addressed early intervention in a separate chapter. Adoption varies across states, health plans and programs, so the edition used matters.
It also folded withdrawal management into the main continuum of care instead of listing separate “WM” levels, and it added a chronic care model level for people in stable remission. Partial hospitalization was renamed High-Intensity Outpatient, which makes clear why partial hospitalization is considered outpatient care. Many programs and health plans still use third-edition names, so this guide gives both.
The Six Dimensions of ASAM Assessment
An ASAM assessment looks at six dimensions, or life areas. Together they show how much support a person needs and where. The fourth edition names them this way:
- Intoxication, Withdrawal, and Addiction Medications. Current use, the risk of withdrawal, and whether addiction medication could help.
- Biomedical Conditions. Physical health problems, pregnancy, and other medical care needs.
- Psychiatric and Cognitive Conditions. Co-occurring mental health conditions, plus memory or thinking problems.
- Substance Use-Related Risks. The chance of continued use or overdose without more support.
- Recovery Environment Interactions. The home environment, work, relationships, housing, and other social determinants of health.
- Person-Centered Considerations. The person’s own preferences, barriers to care, and need for motivational enhancement.
Dimensions 1 through 5 shape the level of care recommendation. Dimension 6 guides a shared decision about where the person is able and willing to take part. In the third edition’s dimension list, readiness to change had its own slot, and the fourth edition weaves it through the whole assessment instead.
These are also the areas to think through if you are asking yourself, “Do I need an IOP?” before an assessment.
ASAM Levels of Care at a Glance
The fourth edition groups the ASAM Criteria levels into four broad levels, numbered 1 through 4, with sub-levels inside each. Outpatient hours are set by the criteria: fewer than 9 hours a week of clinical services at Level 1.5, 9 to 19 hours at Level 2.1, and at least 20 hours at Level 2.5 [4].
| Level (fourth edition name) | Older third-edition name | Typical intensity and setting | Who it may fit |
|---|---|---|---|
| Early intervention (now its own chapter) | Level 0.5, Early Intervention | Screening, education, brief intervention | People at risk who do not meet criteria for a substance use disorder |
| 1.0 Long-Term Remission Monitoring | New level | Periodic check-ins, medication management | People in stable remission |
| 1.5 Outpatient Therapy | Level 1, Outpatient Services | Fewer than 9 hours a week | People with a stable home and milder needs |
| 1.7 Medically Managed Outpatient | Takes in outpatient withdrawal management (1-WM) | Outpatient visits with medical services | People needing addiction medication or mild withdrawal care |
| 2.1 Intensive Outpatient | Same name | 9 to 19 hours a week | People who need structure but can live at home |
| 2.5 High-Intensity Outpatient | Partial Hospitalization | 20 or more hours a week | People who need daily treatment without overnight care |
| 2.7 Medically Managed Intensive Outpatient | Takes in 2-WM | Intensive outpatient with medical management | People with more medical or withdrawal needs |
| 3.1 Clinically Managed Low-Intensity Residential | Same name | 24-hour living setting; 9 to 19 clinical hours per week | People who need a stable place to live during treatment |
| 3.5 Clinically Managed High-Intensity Residential | Same name, now also covers 3.2-WM | 24-hour living setting; at least 20 clinical hours per week | People at high risk of use at home |
| 3.7 Medically Managed Residential | Medically Monitored Intensive Inpatient | 24-hour nursing and physician oversight | People with serious medical, psychiatric, or withdrawal needs |
| 4 Medically Managed Inpatient | Medically Managed Intensive Inpatient | Hospital, 24-hour medical care | People who need acute hospital care |
The biggest practical gap in the middle of the scale is between Levels 2.1 and 2.5. Our IOP vs PHP comparison lays out the differences in hours, structure, and daily life.
Each Level of Care Explained
The sections below describe what each part of the full continuum is like for the person in treatment.
Withdrawal Management (Detox)
Withdrawal management, often called detox, supports safe care during withdrawal. The fourth edition integrates it into treatment levels, including clinically managed Level 3.5 and medically managed levels such as 1.7, 2.7, 3.7, and 4. Alcohol and benzodiazepine withdrawal can be dangerous; the right setting depends on an individual assessment.
Withdrawal management by itself is not a complete course of treatment. It is usually a first step before therapy-based care. Detox can take place in a hospital, a residential unit, or an outpatient clinic with medical staff.
Some outpatient programs, including several in South Florida, do not offer detox on site and arrange it with a licensed detox center instead. Whether someone needs detox before IOP depends on the substance, how much and how long it was used, and medical history.
Level 1: Outpatient Care
Level 1 is the least intensive part of the continuum. Level 1.5 is standard outpatient therapy, meaning individual or group therapy for fewer than 9 hours a week while the person keeps working and living at home. Level 1.7 adds medical care, such as medication for opioid or alcohol use disorder.
Level 1.0 is new in the fourth edition. It offers long-term recovery support through regular check-ins for people whose substance use is in remission. It follows a chronic care model, where addiction is tracked over time like other long-term health conditions.
Level 2.1: Intensive Outpatient (IOP)
An intensive outpatient program (Level 2.1) provides 9 to 19 hours of structured treatment a week. Sessions often run three to five days a week, sometimes in the evening, so people can keep a job or school schedule.
IOP centers on group therapy, with individual sessions, relapse prevention, and recovery skills practice added. Many programs include case management to help with work, housing, or legal matters, and some offer medication for opioid or alcohol use disorder.
People often step into IOP after a more intensive level, or start there when home life is stable. A closer look at how IOP works week to week covers scheduling, group types, and the first few sessions.
Level 2.5: Partial Hospitalization (High-Intensity Outpatient)
Level 2.5, called partial hospitalization in the third edition, is High-Intensity Outpatient in the fourth edition. It provides at least 20 clinical hours per week, often across five days. Level 2.7 adds medically managed intensive outpatient capabilities, so Level 2.5 is not the only form of intensive outpatient care.
Days in partial hospitalization programs usually mix group therapy, individual sessions, and psychiatric follow-up. Medication management is often part of the day as well.
People who need daily therapy and close monitoring of co-occurring conditions, but not 24-hour care, are the usual fit for a partial hospitalization program.
Levels 3 and 4: Residential and Inpatient Care
Residential care (Level 3) provides a 24-hour living setting with structured support. The amount of clinical treatment and availability of nursing and medical care vary by sublevel. It can fit people who need that support across one or more assessment dimensions, rather than only distance from triggers.
Level 3.1 is lower intensity, and Level 3.5 is clinically managed high-intensity residential care. Level 3.7 adds medical and nursing care around the clock. Level 4 is hospital-based care for acute physical health or psychiatric conditions.
These levels fit people whose home setting is unsafe, whose withdrawal or medical risk is high, or who have not stayed stable at an outpatient level. A residential stay also means time away from work and family, which some people can arrange and others cannot. Those tradeoffs are laid out in our comparison of inpatient vs IOP care.
How Placement Is Decided
Placement starts with an assessment, not a self-diagnosis. A trained clinician asks about a person’s medical history, substance use, mental health, home life, and goals, then rates risk in each of the six dimensions. The areas of highest risk help determine the appropriate level, and the person’s preferences shape the final plan.
The initial level is a starting point. The criteria favor the least intensive level that is still safe, and a clinician will recommend more intensive services when risk is high in any dimension.
It helps to bring a list of current medications, past treatment, and health conditions to the assessment. For one level’s requirements, see the breakdown of who is eligible for PHP.
Moving Along the Continuum of Care
The continuum of care works in both directions. People move to a different level as their needs change, and the aim is to avoid gaps between levels.
Stepping Down
Many people step down to a less intensive level as they stabilize. A common path is residential care, then PHP, then IOP, then standard outpatient therapy.
The move from PHP to IOP is a frequent step down. It reduces weekly hours and gives back time for work and family while therapy continues. Time at each level depends on progress, and the chapter on how long does partial hospitalization last covers typical ranges.
Stepping Up and Continuing Care
Stepping up is just as normal. A return to use, a mental health crisis, or a change at home can mean a more intensive level is safer for a while. That is the continuum doing what it was built to do.
After a structured program ends, care usually continues at a lower intensity through outpatient therapy, mutual support groups, sober living, and recovery support services. Many people keep a support structure in place for months or years to support recovery. Our post on life after a structured program explains the usual next steps once IOP ends.
Insurance and Medical Necessity
Health plans may use level-of-care criteria to assess medical necessity. A clinical recommendation does not guarantee coverage: benefits, network rules, authorization requirements and other plan terms also matter. Some plans authorize a period of care and review progress before approving more.
Florida licenses substance use disorder (SUD) services under Chapter 397 of the Florida Statutes, which uses its own names for service types, such as “day or night treatment” and “intensive outpatient treatment” [5]. Florida plans and providers may use these state terms, third-edition ASAM names, or fourth-edition names, so it helps to ask which version a plan follows.
Insurance coverage can differ between plans, even for the same level. Questions about whether insurance covers IOP usually come down to the plan’s medical necessity rules and its provider network.
Choosing a Level of Care
The right level matches current risk and needs, and more hours are not automatically better. When talking with a clinician, these questions can help:
- Is there any risk of serious withdrawal, and where can it be managed safely?
- Are there physical or mental health conditions that need regular medical care?
- Is home a safe, supportive place to recover right now?
- How many hours a week can work, school, or family realistically allow?
- What happens if this level turns out to be too much or too little?
Outcome research can also inform the choice, and we review the evidence on PHP outcomes here.
If substance use ever feels like an emergency, call 911. For a mental health crisis, call or text 988. SAMHSA’s National Helpline, 1-800-662-4357, offers free, confidential treatment referrals 24 hours a day.
Frequently Asked Questions About ASAM Levels
What Are the Different Levels of Addiction Treatment?
The ASAM Criteria Fourth Edition groups addiction treatment into four broad levels. Level 1 is outpatient care, Level 2 covers intensive outpatient and partial hospitalization, Level 3 is residential care, and Level 4 is hospital inpatient care. Withdrawal management is built into the medically managed sub-levels rather than listed on its own.
What Is ASAM Level 2.5?
Level 2.5 provides high-intensity outpatient care with at least 20 clinical hours per week. The third edition called it partial hospitalization, and the fourth renamed it High-Intensity Outpatient. People sleep outside the program, and a sample schedule shows what a typical PHP day looks like.
What Is a 3.7 Level of Care?
Level 3.7 is medically managed residential care. It provides a 24-hour setting with nursing care and physician oversight for people with serious withdrawal, medical, or psychiatric needs. The third edition called it Medically Monitored Intensive Inpatient, and the fourth edition renamed it and folded withdrawal management into it.
Is Partial Hospitalization Inpatient or Outpatient?
Partial hospitalization is an outpatient level of care, even though the name includes the word “hospitalization.” People attend structured treatment for much of the day and sleep at home or in sober living. Our chapter on whether partial hospitalization counts as inpatient explains how the two differ.
What Is a 2.7 Level of Care?
Level 2.7, Medically Managed Intensive Outpatient, is a new level in the fourth edition. It pairs intensive outpatient treatment with medical management, including withdrawal management and addiction medications. It may suit someone who needs medical oversight during the day but can safely sleep at home.
Find the Level That Fits
The ASAM levels of care exist so treatment can match where a person is today and change as they do. If you are considering outpatient treatment in Broward County, you can learn how intensive outpatient treatment in Pompano Beach is structured and ask for an assessment to see which level fits.
Medical disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Level of care decisions should be made with a qualified clinician after an individual assessment. If you are in crisis, call or text 988, or call 911 in an emergency.
Sources
- American Society of Addiction Medicine. About the ASAM Criteria. https://www.asam.org/asam-criteria/about-the-asam-criteria
- American Society of Addiction Medicine eLearning Center. ASAM Criteria Education. https://elearning.asam.org/asam-criteria-education
- American Society of Addiction Medicine. Crucial Changes to Substance Use and Co-Occurring Disorder Care Standards Published (October 5, 2023). https://www.asam.org/news/detail/2023/10/05/crucial-changes-to-substance-use–co-occurring-disorder-care-standards-published
- American Society of Addiction Medicine. The ASAM Criteria, Fourth Edition, Volume 1: Adults: Overview. https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/quality-science/adult-criteria/asam_overview-of-adults_final.pdf
- The Florida Senate. 2026 Florida Statutes, Section 397.311, Definitions. https://www.flsenate.gov/laws/statutes/2026/397.311
